Pap Smear

This week I would like to discuss an important exam that should be an essential to a woman’s sexual health that is a Pap smear.

All women who are or who have been sexually active, or who have reached age 18, should have an annual Pap smear. It is an early way to detect pre-cancerous conditions and hidden, small tumors that may lead to cervical cancer; hence if detected early, cervical cancer can be cured.

A Pap smear is a way to look at a sample of cells taken from a woman's cervix. The test is used to look for changes in the cells of the cervix that show cervical cancer or conditions that may develop into cancer.

It is a simple procedure done during a pelvic exam. The pelvic exam may be a bit uncomfortable but the Pap smear itself should be painless. A doctor uses a device called a speculum to widen the opening of the vagina so that the cervix can be examined. A plastic spatula and small brush are used to collect cells from the cervix. After the cells are taken, they are placed on a slide and fixed with an alcohol-based solution. The slide is sent to a lab for testing. (Figure 1)

 Figure 1. (Taken from WebMD)

It may take two to four weeks to get the test results. The results can either be normal or abnormal. A normal Pap smear means the cells from the cervix look normal. An abnormal Pap smear means the cells do not look normal. Sometimes repeat Pap smears are needed. A number of other tests may need to be done, such as a colposcopy (the use of a special microscope to examine the cervix and vagina). Pap smears can occasionally show signs of infection but cannot be relied on to screen for sexually transmitted diseases (STD). Other tests are necessary to determine the presence of an STD.

An abnormal Pap smear does not necessarily mean that cancer cells were found during the examination. There are many causes for abnormal Pap smear results and hence your doctor will determine if further testing is necessary. A repeat Pap smear may be necessary if you had an infection at the time of the test or if there were not enough cells collected during the test. Decreased levels of the female hormone estrogen also can influence Pap smear results. If the results of the repeat Pap smear are still abnormal, your doctor may recommend that you have a colposcopy to further evaluate the problem.

A colposcopy is an examination of the cervix and the walls of the vagina. During the examination, a speculum is inserted into the vagina (as done in a Pap smear). Your doctor then looks through a magnifying instrument called a colposcope to detect cervical problems that cannot be seen by the eye alone. During the colposcopy, the colposcope remains outside the vagina. Biopsies (tissue samples) of the abnormal cervical area may be taken. A colposcopy is not always necessary immediately after an abnormal Pap smear and so one should ask your doctor about their options.

It's a good idea for women who are over 18 or who engage in sex to get a pelvic exam once a year. The exam should also include a yearly Pap smear. Some women who have a higher risk of cancer may need to have a Pap smear more often. Women who have had normal Pap smear results for several years and have only one sex partner may need a Pap smear less often.

Pre-cancerous conditions of the cervix seldom cause symptoms hence few symptoms, if any, are noted between Pap smears. For problems to be detected, a pelvic examination and a Pap smear are usually required. When cancer is present in the cervix, the most common symptom is abnormal bleeding. Bleeding may start and stop between regular menstrual periods, or it may occur after sexual intercourse. Abnormal vaginal discharge is another symptom. Pain is NOT an early warning sign of the disease. These symptoms are not sure signs of cancer and therefore should seek medical advice if any of these symptoms last longer than two weeks.

A Pap smear is a screening test that can be easily performed and so prevent the most prevalent female cancer – cervical cancer.

In the coming weeks I will discuss both male and female sexual health problems, the next topic will be on the testicular exam.

Excerpts taken from the Cleveland Clinic.

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